From the Center for Translational Injury Research (J.W., N.M., J.B.H., C.E.W., B.A.C.), Department of Surgery (D.M., J.B.H., C.E.W., J.D.L., B.A.C.), Department of Pathology and Laboratory Medicine (Y.B.), Department of Emergency Medicine (S.M.), The McGovern Medical School at the University of Texas Health Science Center; and The Red Duke Trauma Institute at Memorial Hermann Hospital (D.M., Y.B., S.P., R.C., J.B.H., J.D.L., B.A.C.), Texas Medical Center, Houston, Texas.
J Trauma Acute Care Surg. 2020 Jan;88(1):87-93. doi: 10.1097/TA.0000000000002498.
Following US military implementation of a cold-stored whole blood program, several US trauma centers have begun incorporating uncrossmatched, group O cold-stored whole blood into civilian trauma resuscitation. We set out to evaluate the safety profile, transfusion reactions events, and impact of low-titer group O whole blood (LTO-WB) at our center.
In November 2017, we added LTO-WB to each of our helicopters and to our emergency department (ED) refrigerator, alongside that of existing red blood cells and plasma. We collected information on all patients with trauma receiving prehospital or ED transfusion of uncrossed, emergency release blood products between November 2017 and June 2018. Patients were divided into those receiving any LTO-WB and those receiving only red blood cell and or plasma (COMP). Serial hemolysis panels were obtained at 3 hours, 24 hours, and 48 hours. All data were run using STATA 12.1. Statistical significance was set at p < 0.05.
One hundred ninety-eight patients received LTO-WB and 152 patients received COMP. There were no differences in age, sex, or mechanism. The LTO-WB patients had higher chest Abbreviated Injury Scale scores (median, 3 vs. 2; p = 0.027), as well as worse arrival base excess (median, -7 vs. -5; p = 0.014) and lactate (5.1 vs. 3.5; p < 0.001). The LTO-WB patients received less post-ED blood products than the COMP patients (median, 0 vs. 3; p = 0.001). There was no difference in survival (LTO-WB, 73%; COMP, 74%; p = 0.805). There were only two suspected transfusion reactions, both in the COMP group (p = 0.061). There was no difference in hemolysis panel values. Controlling for age, severity of injury, and prehospital physiology, LTO-WB was associated with a 53% reduction in post-ED blood product transfusion (odds ratio, 0.47; 0.23-0.94 95% CI; p = 0.033) and two-fold increase in likelihood of survival (odds ratio, 2.19; 1.01-4.76 95% CI; p = 0.047).
Low-titer group O whole blood has similar evidence of laboratory hemolysis, similar transfusion reaction rates, and is associated with a reduction in post-ED transfusions and increase likelihood of survival.
Therapeutic, Level II.
在美国军方实施冷藏全血计划后，一些美国创伤中心开始将未经交叉配血的 O 型冷藏全血纳入民用创伤复苏。我们旨在评估本中心低滴度 O 型全血（LTO-WB）的安全性概况、输血反应事件和影响。
2017 年 11 月，我们在我们的每架直升机和急诊部（ED）冰箱中添加了 LTO-WB，与现有的红细胞和血浆一起。我们收集了 2017 年 11 月至 2018 年 6 月期间接受院前或 ED 输注未经交叉、紧急放行的血液制品的所有创伤患者的信息。患者分为接受任何 LTO-WB 和仅接受红细胞和/或血浆（COMP）的患者。在 3 小时、24 小时和 48 小时时获得连续溶血面板。所有数据均使用 STATA 12.1 运行。统计学意义设为 p < 0.05。
198 名患者接受 LTO-WB，152 名患者接受 COMP。两组在年龄、性别或机制方面无差异。LTO-WB 患者的胸部损伤严重程度评分更高（中位数，3 分与 2 分；p = 0.027），入院基础不足（中位数，-7 与-5；p = 0.014）和乳酸（5.1 与 3.5；p < 0.001）更差。LTO-WB 患者在 ED 后接受的血液制品少于 COMP 患者（中位数，0 与 3；p = 0.001）。两组的存活率无差异（LTO-WB，73%；COMP，74%；p = 0.805）。仅在 COMP 组中发现了两例疑似输血反应（p = 0.061）。溶血面板值无差异。在控制年龄、损伤严重程度和院前生理学因素后，LTO-WB 与 ED 后血液制品输注减少 53%相关（比值比，0.47；0.23-0.94 95%置信区间；p = 0.033），且存活率增加一倍（比值比，2.19；1.01-4.76 95%置信区间；p = 0.047）。
低滴度 O 型全血具有相似的实验室溶血证据、相似的输血反应率，与 ED 后输血减少和存活率增加相关。
治疗，II 级。
